POS0208 STRESS AT HOME IS COMMON AND HAS SIGNIFICANT ASSOCIATION WITH MARITAL STATUS, HIGHER DISEASE ACTIVITY, COMORBIDITIES, AND WORSE QUALITY OF LIFE AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT
Authors: M. Haroon, S. Asif, S. Ullah, F. Hashmi, S. Javed
Journal: Annals of the Rheumatic Diseases (2022)

Background In chronic inflammatory diseases like rheumatoid arthritis (RA), psychological stress is widely recognised as an important risk factor to negatively affect the disease course. Perceived stress can potentially induce the disease exacerbation, but on the other hand, the disease itself might produce significant stress to patients thus the vicious circle is formed and maintained. Objectives We aimed to examine the prevalence of mental/emotional stress at home and its associations among patients with Rheumatoid arthritis. We addressed this question using real-world data from the PRIME registry. Methods This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. The SF-12 Physical Component Score (PCS-12) and Mental Component Score (MCS-12) was also measured. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts, tender joint counts, deformed joint counts, and DAS-28. All participants were directly inquired at the interview during the time of patient enrolment about the presence or otherwise of mental/emotional stress at home, and to rate it from 1-3 (mild, moderate, severe). For better understanding and ease of statistical analysis, dichotomous variable was made with moderate-to-severe stress patients were categorised into one group and none-to-mild stress patients into second group. Results The data from consecutive 1016 RA patients (mean age 40.8±13 years, 78.6% female, disease duration of 65±67 months) was reviewed. Forty-nine percent of patients accepted to have moderate-severe stress at home. Female gender (p=0.003), low education status (p=0.050), being unmarried (p=0.051), and MCS, PCS, CCI (p&lt;0.001) were associated with moderate-severe stress. However, no statistical association of age and disease duration was noted. On univariate analysis, significant association of moderate-severe stress at home was noted with deformed joint counts (p=0.003), higher DAS-28 scores (p&lt;0.001), low education status (p=0.02) and being married (p&lt;0.001). Weak statistical association of age (p=0.30), disease duration (p=0.12), low education status (p=0.14), female gender (p=0.24) was noted. On multiple logistic regression analysis, a significant association of moderate-severe stress at home was observed with higher DAS-28 scores (OR 2.38, CI 2.00-2.84, p&lt;0.001), MCS-12 (OR 0.65, CI 0.61-0.69, p&lt;0.001), comorbidities-CCI (OR 1.41, CI 1.15-1.74, p=0.001) and being unmarried (OR 0.55, CI 0.36-0.83, p=0.005). The final regression model resulted in a statistically significant improved association/prediction of worse moderate-severe stress at home (R square=71%). Following variables were included in multiple stepwise regression analysis: age, disease duration, gender, education status, marital status, comorbidities index, major trauma/stress in last one year, DAS-28, MCS-12 and PCS-12 scores. Conclusion Nearly half of the cohort was noted to have moderate-severe level of stress at home, and is associated with important adverse clinical outcomes. These findings demonstrate an important need for integration of rheumatologic, social workers and mental health services Disclosure of Interests Muhammad Haroon Speakers bureau: Novartis, Abbvie, Pfizer, Roche, Grant/research support from: Abbvie, Sadia Asif: None declared, Saadat Ullah: None declared, Farzana Hashmi: None declared, Saba Javed: None declared